A spike in syphilis cases and sharp cuts in state funding to Philadelphia for HIV/AIDS are presenting a challenge to public-health workers tasked with preventing the spread of sexually transmitted diseases.
Infectious syphilis rose 45 percent in the city last year, with far greater increases among women – a group whose reported cases, while still small, barely registered until recently.home hiv test, hiv self test, home hiv kit
“It is very disturbing to see these outbreaks among women,” said Jo Valentine, chief of syphilis elimination and STD disparities at the U.S. Centers for Disease Control and Prevention.
Local health officials have tamped down a handful of similar eruptions around the country in the last few years, Valentine said. But a 34 percent cut in state HIV funding for the city beginning July 1 – some of the money is already gone – could hamper efforts in Philadelphia, home to more than half the HIV patients in Pennsylvania.home hiv test, hiv self test, home hiv kit
The $2 million was used for HIV testing and prevention in minority communities, which have the highest rates of sexually transmitted diseases nationwide. It would have covered tests for an estimated 8,000 people next year, and prevention and risk-reduction services for 4,000.home hiv test, hiv self test, home hiv kit
All state-funded support groups aimed at prevention have already ceased to operate.
Danielle M. Parks leads a five-week risk-reduction program for heterosexual black women. The health educator’s final session of SISTA – Sisters Informing Sisters about Topics on AIDS, which reached 136 women last year – was two weeks ago.home hiv test, hiv self test, home hiv kit
“These women need this,” Parks said, because otherwise “they are going to continue life as usual.”
During her last group, she told students about women who had recently tested positive for HIV. One was a 43-year-old Latina whose husband of 16 years, it turned out, had been aware of his infection for three years but did not know how to tell his wife. Another was a 36-year-old African American mother of three with private insurance and a college degree.home hiv test, hiv self test, home hiv kit
“It doesn’t matter if you have been in a relationship for three months or 30 months,” Parks told them. “Just having sex with someone who is African American puts you at higher risk, because the rates within the community are so high.”
Syphilis is spread through skin-to-skin sexual contact and thus is more infectious than HIV, which is passed in bodily fluids. But they follow similar patterns, and tactics employed to prevent one often do the same for the other. Testing is considered the prime strategy.home hiv test, hiv self test, home hiv kit
“When people learn their status and it is positive, their behavior changes,” said David S. Metzger, an HIV prevention researcher at the University of Pennsylvania School of Medicine. Even if the test is negative, he said, “just the consideration of infection helps people to practice safer behaviors.”
STD rates are driven in part by an economic downturn that is leaving more people without insurance. And some women who are already living on the edge are more likely to barter with their bodies.home hiv test, hiv self test, home hiv kit
“People will have sex in order to stay in an apartment or house, basically survival sex,” Metzger said.
Then there’s fading memory. AIDS is no longer a death sentence, and as syphilis declined through the 1990s and the early 2000s, risky behaviors have increased, experts say. This is especially true for heterosexuals, who typically do not consider themselves to be in danger.home hiv test, hiv self test, home hiv kit
Blacks are eight times as likely as whites to be found to have primary and secondary syphilis, the key infectious stages; Latinos are four times as likely, according to the CDC.
Men are five times as likely to be infected as women. The category “men who have sex with men” (MSM), which reflects behavior rather than self-identity, accounts for roughly two-thirds of cases here and nationally.home hiv test, hiv self test, home hiv kit
Rates in all groups had risen through 2008, the most recent year for which national data are available.
The biggest jump in Philadelphia’s 2009 statistics is based on the smallest numbers: women ages 15 to 29 went from five cases to 23. But those are key childbearing years, and infection during pregnancy can cause congenital syphilis.
“A single case is tragic,” said Lenore Asbel, an infectious disease specialist in the Philadelphia Department of Public Health’s STD clinic.home hiv test, hiv self test, home hiv kit